Interoperability: The Promise of Healthcare

How many doctors have you seen in your lifetime? Don’t know or remember? You’re not alone – the average American patient will see nearly 19 different doctors during their lifetime. Nineteen different offices. Nineteen different medical charts. Nineteen different phone numbers. Nineteen different calls to track down your records. Now, can you even remember your last five doctors?

The future: Imagine this, you visit your doctor – or any doctor for that matter – and they quickly pull up your medical history. Vaccinations when you were a child? Check. Currently on a hypertensive medication? Check. Pre-disposed to a medical condition? Yep, that’s in there, too. No more arriving 20 minutes early to the doctors’ office to fill out the industry-average seven pages of paper forms. Your records – past and present – are already being reviewed by your trusted provider.

Beyond the sheer convenience, the accuracy and completeness of having your entire medical history available at the fingertips of your provider can impact your well-being and scope of care. Can you accurately remember all procedures you’ve had? And when? Or all the medications you’ve ever taken? With dates? Imagine if you were a senior. Not just daunting, but nearly impossible. Instead of going over just snippets of what you actually remember, your doctor is empowered to holistically review your entire medical history with the potential to make more informed decisions about your health.

Seem like a pipedream? If you were to ask a mere decade ago, most would have agreed. As recently as 2007, 88 percent of physicians were still charting on paper. And those physicians on an EHR system – who were paying a premium – were almost exclusively using a localized, server based platform with no connectivity. For cost perspective, according to HealthIT.gov, the average upfront cost of implementing an EHR is $33,000 per provider plus an on-going fee of $4,000 yearly, a cost-prohibitive amount for most private practices.

Fast forward to 2009 and the passage of the HITECH Act which provided billions of dollars of incentives for providers to implement an electronic health record. In addition to the incentives, new vendors appeared on the market who provided electronic health record platforms completely free-of-charge, allowing providers to reinvest the incentives in their practice as additional staff, new equipment, etc.

With the immediate incentives of the HITECH Act, and the threat of future financial penalties, physician adoption rates increased dramatically yearly nationwide. Records that were once inaccessible on paper, were now stored within an electronic format, albeit if stored on an office based server. Progress, while incremental, was advancing.

The second large, broad shift within the healthcare ecosystem is occurring now as vendors pivot from legacy, server-based systems to cloud-based, finally opening the door to the elusive yet ambitious goal of the true potential of electronic health records: interoperability.

Often bandied around within the health care industry, interoperability means different things to different people. Interoperability, for the context of this article, is the ability for any authorized physician to securely access all clinical chart data regarding a patient, no matter what other physicians the patient has seen. And regardless which different EHR system those other physicians were using.

The first iteration of meaningful use, Stage 1, developed by the Office of the National Coordinator, defined standards with the expectation that EHRs could finally talk to each other and exchange patient records in a standardized manner, without having to directly integrate one by one with every EHR or hospital system. However, prior to 2011, there were no mandated standards for common patient chart file formats, encryption technologies or transmission protocols, leaving each vendor to develop their own standards.

The ONC adoption of a standardized format was an incredibly necessary step forward, but was ultimately insufficient to solve the complicated interoperability problem as vendors, mainly the large, enterprise solutions, either willfully blocked the exchange of data or charged exorbitant rates.

At the moment, the major challenge is ensuring that EHR vendors are not raising financial or bureaucratic barriers to the data. Congress and ONC have clearly stated that they will not tolerate this kind of data blocking and many EHRs have taken great strides to provide greater accessibility, much to the chagrin of the obstructionists.

Additional hurdles remain before EHRs can truly interoperate, including obstacles such as knowing which EHR contains a specific patients’ medical information and then securely authorizing access to that data prior to transmission.

Because of the enormous benefits, convenience and potential impact, both patients and providers are demanding greater access to shared data. We’ve reached a critical point in the interoperability process with many challenges lying ahead, but the promise and benefits of true interoperability are within reach on the not-so-distant horizon.